The effect of the relationship between positive symptoms andanxiety and impulsivity on smoking in schizophrenia

Purpose: Smoking is one of the main reasons of premature deaths and it is among the main causes of preventable diseases and deaths. Smoking is common among patients with schizophrenia. High smoking rates of patients who were diagnosed with schiozphrenia was tried to explanied by different hypotheses such as self-medication, to decrease the side effects of antipsychotics, to improve cognitive problems and to provide social interaction. The purpose of this study is to evaluate positive and negative symptoms, the effect of the positive findings on anxiety and impulsivity, to determine smoking behaviour and to examine relationship between these in patients who are followed with schizophrenia and schizophrenia spectrum disorder diagnoses in the psychiatry outpatient clinic of the Department of Mental Health and Diseases of Dokuz Eylül University Hospital Material and Method: The sample group of the study consisted of patients diagnosed with schizophrenia, schizoaffective and schizophreniform disorder according to ICD-10 in the psychiatry outpatient clinic of the Department of Mental Health and Diseases of Dokuz Eylül University Hospital. The patients were included in the study consecutively, and a face-to-face interview was conducted with these individuals by a single interviewer on the day they applied for outpatient clinic examination.150 patients were included in the study. Case Data Registration Form, Positive and Negative Syndrome Scale (PANSS), Barrat Impulsivity Scale- 11 (BIS-11), Fagerström Nicotine Dependence Test (FNDT), State-Trait Anxiety Inventory (STAI) were applied to the patients. Findings: 94.3% of men and 82.3% (p = 0.018) of women were diagnosed with schizophrenia. 45.5% of men and 17.7% (p = 0.001) of women smokeD; 36.4% of men and 12.9% (p = 0.005) of women used alcohol. There was no significant difference in FTNB XI between males and females (p = 0, 785). PANSS, STAI and BIS-11 scale scores did not differ significantly between men and women. When the patients were divided into two groups according to high and low positive PANSS scores, there was no significant difference in sociodemographic terms except for marital status (p = 0.002). A statistically significant difference was found between the high and low positive PANSS groups in terms of the number of psychiatric hospitalizations (p = 0.007) and the types of antipsychotics used (p = 0.019). While there were no significant results between these two groups in terms of smoking (p = 0.604) and FNBT (p = 0.187), statistically significant (p <0.001) results were obtained in terms of anxiety and impulsivity. No relationship was found between PANSS positive (p = 0.563) and negative (p = 0.979) subscale scores and smoking. There was a statistically significant positive moderate correlation between the PANSS positive subscale score and anxiety (p <0.001) and impulsivity (p <0.001); There was no significant relationship between FNBT (p = 0.379). There is a statistically significant (p <0.001) positive moderate correlation between the STAI anxiety scores and the BIS-11 impulsivity scores. There was no significant relationship between STAI-State anxiety (p = 0.262), Trait anxiety (p = 0.449) and BIS-11 impulsivity scores (p = 0.255) and FNBT. Results: In our sample, smoking rates were lower than those stated in psychiatric sources and are similar to the general population of our country. The results of our study showed that positive and negative symptoms are not related to smoking. There are conflicting results regarding this in the literature. Likewise, no significant results were obtained regarding the degree of cigarette addiction with positive symptoms. This may be due to variables such as methodological differences and sample size. It was found that positive symptoms were significantly associated with anxiety and impulsivity. There are similar results in the literature. In patients with schizophrenia, anxiety and impulsivity are associated with increased risk of violence and suicide, as well as decreased functionality, and controlling positive symptoms may be helpful in reducing the risk in these areas. These risks should be considered in the clinical evaluation of patients with predominant positive symptoms. The significant relationship between anxiety symptoms and impulsivity may indicate the need for effective use of both pharmacological and non-pharmacological treatments for anxiety symptoms.